Healthcare Provider Details

I. General information

NPI: 1366716920
Provider Name (Legal Business Name): METTE O MADSEN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 EMBARCADERO
OAKLAND CA
94606-5213
US

IV. Provider business mailing address

402 W BROADWAY STE 400
SAN DIEGO CA
92101-3554
US

V. Phone/Fax

Practice location:
  • Phone: 510-832-4383
  • Fax: 510-550-1981
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number104912
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-12-10105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: